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Community Needs Assessment - Survey for TGC Clients
1.
What is your age group?
Under 12
12-17
18-24
25-44
45-64
65+
2.
Who are you completing this survey for?
Myself
My child (0-5)
My child (6-12)
My teenager (13-17)
An adult family member
Other (please specify)
3.
Have you or a family member served in the military?
Yes
No
4.
What services do you or your family member receive at The Guidance Center? (Select all that apply.)
Therapy / Counseling (talking with a provider to help with mental health or substance use concerns)
Case Management (help connecting to housing, benefits, healthcare, or other supports)
Medication Management (prescribing and monitoring medications for mental health conditions)
Crisis Services (immediate help during a mental health or substance use crisis)
School-Based Services (mental health support provided through schools)
Family & Early Childhood Services (support for families and young children)
Community Support Services (CSS) (help with daily living skills and independence)
Care Coordination (help managing care across providers and services)
Peer Support (support from someone with lived experience)
Psychiatric Rehabilitation (skill-building to support recovery and daily functioning)
Employment / Supported Employment (help finding and keeping a job)
Other (please specify)
5.
Which TGC location(s) do you typically visit? (select all that apply)
Leavenworth
Atchison
Jefferson County / Oskaloosa
School-Based
Guiding Lights Crisis Center
Other (please specify)
6.
On a scale of 1-4, how was your experience scheduling your first appointment with us?
1=Very Difficult
2=Difficult
3=Easy/Convenient
4=Fast, very easy, highly convenient
1=Very Difficult
2=Difficult
3=Easy/Convenient
4=Fast, very easy, highly convenient
Please share your thoughts on how we can improve appointment scheduling:
7.
Which appointment times are most convenient for you? (select all that apply)
Monday-Friday 7:00 AM – 12:00 PM (Morning)
Monday-Friday 12:00 PM – 4:00 PM (Afternoon)
Monday-Friday 4:00 PM – 8:00 PM (Evening)
Saturday 8:00 AM – 12:00 PM (Morning)
Saturday 12:00 PM – 4:00 PM (Afternoon)
Saturday 4:00 PM – 7:00 PM (Evening)
8.
How do you usually travel to appointments?
Personal vehicle
Ride from someone
RideLV or other public transportation
The Guidance Center van/shuttle
On foot/by bicycle (walking/bike-riding)
I often have trouble getting transportation
9.
How and where would you prefer to receive services? (select all that apply)
TGC Main Office – Leavenworth
TGC Office – Atchison
TGC Office – Oskaloosa (Jefferson County)
School-Based Setting (e.g., at your child’s school)
Community-Based Setting (e.g., local health department, clinic, coffee shop, park)
Online - Telehealth
In-home visit
Other (please specify)
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